Resources PPO/Fee Decisions
Understanding how to properly align your fees is key to maximizing your practice's profitability. But where do you get accurate fee data?
Many doctors do not realize that some dental payers are willing to negotiate fees.
Contract requirements have a direct impact on the doctor and the practice well beyond the fee schedule.
To make a fully informed decision, doctors must analyze each PPO contract to determine the potential for profitability.
Dentists who participate in reduced fee networks should continue to bill full fees on all claims and account for contracted write-offs when posting payments. Doing so will improve the accuracy of fee data used to determine future fee increases, ensure that the latest allowable fees are paid on all claims, allow participating providers to compare the profitability of each PPO contract, and enable providers to analyze the effects of other discounts and patient incentives offered in their practice.
According to a report published by the National Association of Dental Plans, PPO plans represented 63% of the dental benefits market in 2009. Traditional fee-for-service dental plans only represented 17% of the market. Unfortunately, this domination of PPO plans has given some insurance carriers the leverage they need to reduce participating provider fee schedules. In certain areas of the country some of the nation's largest dental carriers appear to be in a bidding war to see who can reduce fees the most without losing a significant number of participating providers. What are your options when fees are reduced?